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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701286
Report Date: 11/05/2024
Date Signed: 11/05/2024 03:31:36 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/17/2024 and conducted by Evaluator Christina Valerio
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20241017164426
FACILITY NAME:BEATRICE HOME CAREFACILITY NUMBER:
342701286
ADMINISTRATOR:CLARK, BEATRICEFACILITY TYPE:
740
ADDRESS:1014 FERNANDO WYTELEPHONE:
(916) 270-3961
CITY:GALTSTATE: CAZIP CODE:
95632
CAPACITY:6CENSUS: 6DATE:
11/05/2024
UNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Beatrice ClarkTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Facility is in disrepair.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to deliver complaint investigation findings. LPA Valerio met with facility staff Etta, and explained the purpose of the visit. LPA Valerio was later met by Administrator Beatrice.

The following has been determined as it relates to the above mentioned allegations. The investigation consisted of LPA observations and an interview with an outside agency.

On 10/24/2024, LPA Villanueva observed 4 of 5 bedrooms to be in good repair. 1 of 5 bedrooms was observed to have holes on the wall where the electrical sockets are located. Electrical sockets were observed to not have covering. The drawer was also observed and the top drawer did not have a cover. Also on the window sill, there were scratch marks. During this visit, LPA observed R1 trying to rip the fabric part of their headboard by hand and teeth.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 4
Control Number 27-AS-20241017164426
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: BEATRICE HOME CARE
FACILITY NUMBER: 342701286
VISIT DATE: 11/05/2024
NARRATIVE
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LPA Valerio reviewed pictures obtained from 10/24/24 visit. LPA observed the side gate to be in disrepair. The side gate drags on the floor once it is open. LPA observed holes in the wall located in R1's bedroom. The holes were located next to an electrical socket, leaving the electrical socket exposed to residents in care.

According to an interview with an outside agency (OA), OA had similar observations of the facility as LPA Villanueva. The OA representative stated the place was a mess. There were dressers broken, bed sheets had holes in them, and there were scratch marks on the window frame.

According to an interview with Administrator Beatrice, Administrator Beatrice stated the damage that occurred in the bedroom were made by R1 due to R1's behaviors.

On 11/05/2024, LPA Valerio observed R1's bedroom. LPA observed the holes next to the electrical socket to be repaired; however, the electrical socket was missing a cover. LPA observed the scratches on the window frame and bed frame still is disrepair. LPA Valerio observed the resident bathroom located in the hall.

Based on interviews and observation, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8) are being cited on the attached LIC-9099D. Failure to correct the deficiency may result in civil penalties. Appeal rights were provided.  An exit interview was conducted, and a copy of the report was left at the facility.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 27-AS-20241017164426
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: BEATRICE HOME CARE
FACILITY NUMBER: 342701286
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/05/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/05/2024
Section Cited
CCR
87303(a)
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87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times… This requirement was not met as evidenced by:
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Licensee stated administrator will have all repairs fixed by POC due date. Administrator will create a plan of fixing any property destruction right away if there is any immediate concern.
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Based on observations and interviews, the licensee did not ensure to keep the 1 out of 5 bedrooms in good repair at all times. This poses a potential health, safety, and personal rights risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4